| NPI | 1154695005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 8758) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00270200) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2020-01-10 |